Anesthesia & Pain Management Compliance Auditors

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Physician Comparative Report for Colonoscopies

Comparative Billing Reports

For those of you who are interested in what data the government is compiling on you and how you compare to your peers, you have the opportunity to listen to an anesthesia specific seminar that is being hosted by CMS through Global Tech, who is the entity gathering and producing the Comparative Billing Report Program.  It is of no surprise that the first anesthesia code that they are focusing on is 00810, anesthesia for lower endoscopic procedures.  The seminar is scheduled on July 12th and the example report produced has some very interesting data.The metrics data that is included in the report focuses on three components:

  1. Average time units appended per visit
  2. Percentage of visits billed without an allowed colonoscopy claim
  3. Percentage of visits where the AA modifier was appended

Physicians who are significantly higher than one of their peer groups on at least one of the above measurements and also were above the 75th percentile in allowed charges ($5,000), with at least 19 beneficiaries during the 2016 calendar year will receive a CBR letter.The metrics actually are calculated from both your state peer group as well as reviewed against the national peer group and judge you on what they deem as value.  There are four categories that providers have as outcomes:

  1. Significantly Higher – Provider’s value is higher than the peer value and the statistical test confirms the significance
  2. Higher – Provider’s value is higher than the peer value, but the statistical test does not confirm significance.
  3. Does Not Exceed- Provider’s value is not higher than the peer value
  4. N/A – Providers does not have sufficient data for comparison.
I hope some of you can join us and take the time to register for the seminar.  It is a learning curve for all of us to determine how CMS will judge value in the future.  The link below is to register for the seminar.

As always, ACE is happy to support you with any coding or auditing needs.  Please contact the ACE office if we can assist you in any way.